Korean journal of ophthalmology : KJO最新文献

Purpose: Pseudophakic corneal edema (PCE) remains a significant postoperative challenge despite advancements in cataract surgery, often delaying visual recovery and affecting refractive outcomes. This study investigates the relationship between keratometric and pachymetric changes during PCE resolution, evaluates factors influencing this process, and examines the efficacy of coenzyme Q10 (CoQ10) as an adjunct therapy.

Methods: A retrospective study was conducted on 88 patients aged 50 years and older who developed PCE after uneventful phacoemulsification. Corneal assessments were performed using Pentacam HR, focusing on keratometric and pachymetric changes. Patients were monitored weekly until PCE resolution, defined as a return of central corneal thickness within ±30 μm of preoperative values. Patients received standard postoperative treatment, with a subset also receiving CoQ10 as an adjunct therapy.

Results: Postoperative visual acuity improved significantly (p < 0.001). Despite pachymetric normalization, persistent keratometric changes were observed, particularly a steepening of posterior curvature (p < 0.001) and increased anterior asphericity (p = 0.047). CoQ10-treated patients exhibited faster edema resolution (p = 0.019), greater reduction in corneal thickness (p = 0.003), and improved transparency. Higher cumulative dissipated energy correlated with increased edema severity (r = 0.419, p < 0.001) and higher cumulative dissipated energy was linked to slower recovery times. Patients with diabetes had a prolonged recovery period compared to nondiabetic patients (p = 0.018), though pachymetric recovery rates were similar. The pachymetric progression index was unreliable in edematous corneas.

Conclusions: While visual acuity and pachymetry improved in all patients, persistent topographic changes suggest incomplete structural normalization. Preliminary findings indicate that adjunctive CoQ10 use may support more efficient corneal edema resolution, as evidenced by faster recovery and favorable structural changes. Further prospective studies are warranted to confirm these observations.

Purpose: To compare the prevalence and characteristics of persistent postoperative discomfort 1 year after keratorefractive lenticule extraction (KLEX) and implantable collamer lens (ICL) implantation.

Methods: This retrospective comparative study included 324 eyes from 324 patients with myopia or myopic astigmatism who underwent bilateral KLEX (n = 227) or ICL implantation (n = 97) at a single center. One year postoperatively, visual outcomes, patient satisfaction, and persistent discomfort symptoms were evaluated using a standardized questionnaire, including symptom frequency, severity, and resolution time.

Results: Visual outcomes and overall satisfaction were high and comparable between the two groups (97.3% for KLEX vs. 99.0% for ICL; p = 0.157). Persistent glare and halos were significantly less frequent in the KLEX group than in the ICL group (glare: 50.2% vs. 64.9%, p = 0.045; halos: 48.9% vs. 63.9%, p = 0.034). The time to resolution for these symptoms was significantly shorter in the KLEX group (p = 0.031 and p = 0.024, respectively). In contrast, dryness was more frequent, severe, and bothersome in the KLEX group than in the ICL group (all p < 0.001), and its resolution time was longer (p = 0.008).

Conclusions: KLEX and ICL implantation showed distinct profiles of persistent postoperative discomfort at 1 year. ICL implantation was associated with higher rates and longer duration of glare and halos, while KLEX was associated with more severe and persistent dryness. These findings underscore the importance of individualized preoperative counseling and patient selection.

Purpose: To develop a flexible electrode for electrical stimulation of extraocular muscles and to evaluate the safety of applying direct electrical stimulation to muscles and its potential effects on ocular tissues in rabbits.

Methods: A flexible electrode was fabricated using a conventional photolithography process. This electrode comprised a 300-nm-thick platinum layer embedded within a 30-μm-thick polyimide cable. In an in vivo study, five rabbits underwent electrical stimulation of the right superior and inferior rectus muscles. Stimulation consisted of electrical pulses (1 pulse per second, 2.0 mA for 0.1 milliseconds) applied for 5 minutes to the right superior rectus muscle, followed by 5 minutes to the right inferior rectus muscle. This regimen was performed three times a week for 4 weeks. Subsequent histological examination was conducted on the conjunctiva, extraocular muscles, sclera, and retina.

Results: Direct electrical stimulation of extraocular muscle using a flexible electrode could successfully elicit eye movement in rabbits. Histologic examination demonstrated no evidence of detrimental effects of the electrical stimulation.

Conclusions: Direct electrical stimulation of extraocular muscles using a flexible electrode could safely elicit eye movement without any ocular damage in rabbits.

Purpose: This study assessed the development of macular edema (ME) and its association with systemic diseases in patients with diabetic neovascular glaucoma (NVG).

Methods: The medical records of 40 patients (45 eyes) diagnosed with diabetic NVG, between January 2017 and April 2022, were retrospectively reviewed. At the time of NVG diagnosis, central retinal thickness (CRT) was measured using optical coherence tomography. The eyes were categorized into groups with ME (CRT ≥300 μm) and without ME. Systemic diseases, ocular parameters, and prior treatments such as panretinal photocoagulation and intravitreal anti-vascular endothelial growth factor injections were compared between the two groups.

Results: Only 6 of the 45 eyes (13.3%) had ME at the time of NVG diagnosis. No significant differences were observed between the ME and non-ME groups in terms of systemic diseases, including hypertension, hyperlipidemia, ischemic heart disease, cerebrovascular accident, and chronic kidney disease. Other clinical characteristics, such as age, sex, body mass index, smoking history, best-corrected visual acuity, intraocular pressure, lens status, and history of ocular treatment, were also comparable between groups.

Conclusions: In patients with diabetic NVG, ME was observed in a minority of cases and showed no significant association with systemic diseases.

Brolucizumab offers improved anatomical outcomes and extended dosing intervals compared to aflibercept, reducing treatment burden. However, postmarketing surveillance and real-world studies have highlighted safety concerns, including intraocular inflammation (IOI), retinal vasculitis, and retinal vascular occlusion, necessitating risk management strategies. To address these concerns, a comprehensive review of clinical trials, real-world data, and safety reports were conducted by an expert panel. This consensus report offers practical, evidence-based recommendations to ensure the safe administration of brolucizumab in patients with neovascular age-related macular degeneration (nAMD). The safety management of brolucizumab in patients with nAMD starts with selecting suitable patient profiles through thorough risk assessments. Educating patients about the risk of inflammation and its symptoms is important, as prompt recognition and early medical attention may help improve outcomes. Close monitoring with frequent follow-ups and the use of widefield fundus imaging or peripheral fundus examination are also necessary for early detection and management of complications. Effective management of IOI includes considering discontinuation of brolucizumab, alternative anti-vascular endothelial growth factor therapies, and corticosteroid treatments based on anatomical location and severity of IOI. Differentiating noninfectious IOI from infectious endophthalmitis is essential to ensure appropriate intervention and safeguard vision. In conclusion, this consensus recommendations emphasized the importance of the evidence-based and patient-centered stepwise approaches that should be considered when prescribing brolucizumab to patients with nAMD. This is not an absolute guideline, and the management should be adapted according to the ophthalmic conditions and the patients' opinions after thorough discussions.

Purpose: To evaluate visual evoked potential (VEP) as a diagnostic tool for amblyopia and determine threshold values for conscription grading.

Methods: Between February 2023 and April 2024, 148 men (mean age, 21.68 ± 3.22 years; range, 19-25 years) who underwent conscription examination were retrospectively reviewed and categorized into three groups based on their best-corrected visual acuity (BCVA) of the eye with poorer vision using Snellen chart criteria: mild amblyopia (active duty [group A], BCVA >0.6), Moderate amblyopia (supplementary service [group B], 0.1< BCVA ≤0.6), or severe amblyopia (wartime labor [group C], BCVA ≤0.1). The primary outcome measures were VEP parameters selected to objectively classify amblyopia severity (groups A-C) and determine diagnostic thresholds relevant to military service grading. These included P100 amplitude, P100 latency, interocular amplitude difference ratio (IADR), interocular latency difference ratio (ILDR), as well as the ratios of P100 amplitude and latency between the amblyopic and nonamblyopic eyes.

Results: With increasing amblyopia severity, P100 amplitude decreased (group A, 9.86 ± 2.87 μV; group B, 6.52 ± 1.96 μV; group C, 4.56 ± 2.00 μV), while P100 latency increased (group A, 114.79 ± 4.81 msec; group B, 117.67 ± 6.20 msec; group C, 122.35 ± 11.84 msec). Significant differences in P100 amplitude were observed among all three groups (p < 0.001). P100 latency showed a statistically significant difference between group C and the other groups (p < 0.001). Receiver operating characteristic analysis revealed that P100 amplitude (5.5 μV), IADR (0.4), and P100 amplitude ratio (0.6) effectively distinguished group A from groups B and C (area under the curve >0.8), while ILDR (0.08) differentiated group B from group C (area under the curve, 0.751).

Conclusions: VEP measures, including P100 amplitude, IADR, and ILDR, show potential for amblyopia diagnosis and differentiation of conscription grades.

Purpose: To evaluate the effectiveness of 0.125% atropine eye drops in controlling myopia progression by analyzing 1-year follow-up data through a multicenter retrospective study in South Korea.

Methods: A retrospective chart review was conducted across five centers, including 121 myopic children (aged 4-11 years) treated with 0.125% atropine between January 2021 and December 2023. An equal number of age-, sex-, axial length (AL)-, and spherical equivalent (SE)-matched untreated individuals (control group) were included. Baseline and follow-up data at 6 and 12 months included visual acuity, autorefraction, AL measurement (IOLMaster 700), and fundus examination. The primary outcome measures were changes in SE and AL compared to controls.

Results: Age, SE, and AL in the treatment group at baseline were 7.5 ± 1.5 years (range, 4 to 11), -3.07 ± 1.65 diopters (D; range, -0.25 to -5.88 D), and 24.39 ± 0.85 mm (range, 22.19 to 26.94 mm), respectively, and these parameters showed no statistical differences compared to the matched controls. SE after 1-year treatment was less myopic in the treatment group (-3.42 ± 1.72 D vs. -3.94 ± 1.92 D, p = 0.019). Similarly, AL was significantly shorter in treatment group compared to the control group (24.65 ± 0.88 mm vs. 24.88 ± 0.80 mm, p = 0.031). The SE change from baseline was -0.33 ± 0.73 D in the treatment group versus -0.91 ± 1.01 D in the control group (p < 0.001). AL increased by 0.25 ± 0.32 mm in the treatment group, significantly less than 0.49 ± 0.24 mm increase in the control group (p < 0.001). Baseline AL and mean keratometry showed no correlation with AL progression (all p > 0.05).

Conclusions: The use of 0.125% atropine eye drops significantly reduced myopia progression, with approximately 50% reduction in AL elongation compared to controls. Given its effectiveness and variable compliance, 0.125% atropine eye drops may serve as a viable alternative to low-dose atropine for myopia control.

Purpose: To investigate the outcomes of brolucizumab reinjection after intraocular inflammation (IOI) development.

Methods: This retrospective study analyzed patients with brolucizumab injections from April 2021 to January 2024. Patients who developed IOI after brolucizumab were included and categorized into subgroups depending on reinjection, discontinuation, and further IOI development.

Results: A total of 472 eyes of 432 patients received brolucizumab injections. Thirty-eight cases developed IOI at least once, and 25 continued brolucizumab. Sixteen cases had no more IOI events, and nine experienced a second or more IOI events. Among the nine cases, three maintained brolucizumab injections despite IOI recurrence. The incidence of IOI was 8.1% based on the number of eyes (38 of 472 eyes) and 2.0% based on the number of brolucizumab injections (50 of 2,468 injections). The incidence of occlusive retinal vasculitis was 0.2% (1 of 472 eyes). The recurrence rate was 23.7% (9 of 38 eyes). The average number of injections between the first brolucizumab injection and the injection date on which IOI first developed was 2.15 times in the no-reinjection group, 3.44 times in the no-IOI-recurrence group, and 2.0 times in the second-IOI-episode group. Time to IOI occurrence in cases with first IOI episode was 18.60 ± 16.73 days, with 15 cases developing IOI within 1 week.

Conclusions: This study elucidates the real-world incidence of brolucizumab associated IOIs, with a description of information related to reinjections after the IOI episodes. A comprehensive understanding of brolucizumab reinjection is essential for its optimal utilization.

Purpose: To determine the current management pattern for hordeolum and chalazion among members of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery (KSOPRS).

Methods: An anonymous web-based survey was emailed to 260 current members of the KSOPRS. The survey comprised five sections: differential diagnosis, treatment strategies for hordeolum, treatment strategies for chalazion, postsurgical care, and pediatric-specific approaches.

Results: Eighty KSOPRS members participated in this study (response rate, 30.8%). Redness, swelling, and pain were the most important factors for differentiating hordeolum from chalazion. For hordeolum, topical antibiotics are preferred by 59 respondents (73.8%), with 49 (83.7%) considering them effective. Most (62 respondents, 77.6%) pursue nonsurgical treatment for 5 to 14 days before considering incision and curettage. For chalazion, treatment practices are split between conservative management and invasive methods. Intralesional steroid injections are recommended by 55 respondents (68.8%), with a preference for diluted triamcinolone acetonide. Relative to hordeolum, chalazion treatment involves less frequent antibiotic use, with only 21 respondents (26.3%) always recommending antibiotic ointments. Tissue biopsy is considered for abnormal changes in the surrounding tissues (72 respondents, 90.0%) and frequent recurrence (46 respondents, 57.5%). The practices differ between pediatric and adult cases among 38 respondents (47.5%), with 31 (81.4%) extending conservative management and delaying surgical interventions in pediatric cases. Anesthesia preferences for pediatric cases varied, with 40 respondents (50.0%) favoring local anesthesia, 19 (23.8%) opting for monitored anesthesia care, and 13 (16.2%) choosing general anesthesia.

Conclusions: This survey of the management of hordeolum and chalazion by KSOPRS members has revealed several interesting common practices that are considered valuable by current practitioners.